Recovery Defined – A Unified Working Definition and Set of Principles

In August 2010, leaders in the behavioral health field, including people in recovery from mental health and addiction problems and SAMHSA met to explore the development of a common, unified definition of recovery. Prior to this conversation it was very apparent as to the need of a common definition. In fact, SAMHSA had separate definitions for recovery from mental and substance use conditions. These different definitions, along with other government agency definitions, complicate the discussion as we work to expand health insurance coverage for treatment and recovery support services.

After many conversations and hard work with our partners in the field, a working unified definition and set of principles for recovery has been developed. The development of a standard, unified working definition of recovery will help assure access to recovery-oriented services for those who need it, as well as reimbursement to providers.

Additionally, SAMHSA recognizes the importance of measuring the outcomes and quality of behavioral health services. As a result, SAMHSA is working to develop a set of measures to help assess a person’s recovery with an emphasis on developing indicators that assess quality of life.

Below you will find the working definition recovery and guiding principles.

Working Definition of Recovery

Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.

Principles of Recovery

Person-driven;

Occurs via many pathways;

Is holistic;

Is supported by peers;

Is supported through relationships;

Is culturally-based and influenced;

Is supported by addressing trauma;

Involves individual, family, and community strengths and responsibility;

Is based on respect; and

Emerges from hope.

Furthermore SAMHSA’s Recovery Support Initiative identifies four major domains that support recovery:

Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;

Home: a stable and safe place to live that supports recovery;

Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and

Community: relationships and social networks that provide support, friendship, love, and hope.

There is no set time requirement for recovery as it is recognized that this is an individualized process whereby each person’s journey of recovery is unique and whereby each person in recovery chooses supports, ranging from clinical treatment to peer services that facilitate recovery.

SAMHSA expects additional comments from the field as this definition evolves, and we continue to work together to help assure recovery services are being provided, reimbursed and measured in a consistent way. Check out SAMHSA’s Recovery Support Initiative for more information on recovery.

71 comments on “Recovery Defined – A Unified Working Definition and Set of Principles”

I appreciate the time and effort being given to increase individual and societal awareness/understanding of the processes related to addiction and mental health- as well as working with the recovery community to find find effective individual-based treatments for these disorders. I wanted to share that I have recently been applying Self-Determination Theory to help me process/define my own experience with psychological trauma and subsequent addiction. By helping me see why I felt/acted the way I did and how that translated into ineffective coping patterns, I have been able to rediscover my intrinsic motivation to survive and thrive! =)
I am wondering, if addiction is a disease, how can the criminal justice system continue to convict and incarcerate people for being ill? Not only does this seem discriminatory and old fashioned, the punitive nature of the Dep. of Corrections can actually impede recovery efforts by triggering debilitating anxiety and alienating/isolating individuals at a time when they really need mental/emotional/moral support. Studies relating to Self-Determination Theory have indicated that the use of external motivators (ie.punishments/rewards) threatens to decrease one’s sense of autonomy and over time can actually have a negative effect on their ability to successfully adopt the recovery principles/habits that will permit them to form their own new/improved way of life. …Just some food for though…

The four domains that support recovery, as listed by SAMHSA, are the foundation of the purpose of Aaron’s House in Madison, WI. www.AaronsHouseMadison.org
Aaron’s House, open since August 2007, has openings today for young men ages 18-26 who desire to build on their recovery.

One thing I would interject would be a way to utilize this definition for patients with diminished intellectual capacity. I have patients who are diagnosed with mental illnesses and MR. Recovery is a bit different for them. I think when you look at factors involved in independent living, you have to indicate being as independent as possible. Some of my patients will always need a certain level of assistance. (In a broader sense, so do we all, but I am talking a bit more specifically here.) They may need someone to manage their money or a place to live where someone makes sure they get their basic needs met. It’s different for each one, and at times these patients seem to continue to go through developmental stages considered those relating to childhood and adolescence well into adulthood. They may continue to develop a higher level of independence as they age if provided resources and training. However, when dealing with the issue of recovery, it is important to make this definition broad enough to encompass patients who have some disabilities that might limit that recovery in some way. I just hope that this is considered as this definition is further developed. I think this is a very good start on a definition and sets some important markers for recovery. It just needs to be able to be utilized for different populations.

I also work with the MR poplulation and think that this definition suits them just as well as it does the rest of the population.

I didn’t read anything in the definition or its principles that specify “independent living” as a measure of recovery. Instead, it addresses “living in a community of their choice” which is as true for MR clients as it is for anyone else….now, those “choices” may be limited to a certain extent for conserved adults or minors but the goal should always be client-centered treatment regardless of the diagnosis.

In order to fully and usefully define “recovery”, it is first necessary to define its goal.

The most sane, humane. economically viable, politically acceptable and socially worthwhile definition of the outcome is:
A LASTING RETURN TO THE NATURAL NON-CRIMINAL STATE OF RELAXED ABSTINENCE INTO WHICH 99% OF THE POPULATION IS BORN.

The history of the last half century shows that this end-result is achieved twice as often by “training” addicts in self-help recovery techniques rather than by “treating” them.

Abstinence and personal control of one’s life are gained not by what others do to us, but by what we do for ourselves.

I think many individuals who either admit to substance use being problematic in their lives or are simply “unrepentant” substance users identify as one percenters! One percent is a very large number of individuals. “Relaxed abstinence” is the last thing that many substance users would label their pre-using state!

Self-help is essential. So is a supportive environment and peer network. Recovery involves becoming responsible for oneself. It also involves a recognition of one’s responsibilities to others – one’s peers, community and society at large.

This definition is long overdue and we welcome its final form.
Our Brief Twelve Step Facilitation training manual has been helping healthcare workers deliver recovery services along these lines to many people for several years.
The Brief Twelve Step Facilitation model has four role players; the client, the healthcare worker, a peer helper/peer group and spiritual adviser/spirituality.
Congratulations and keep up the great work.

May I request a refraiming “by addressing trauma” to read, “by taking into account past trauma.”

1. it is gentler & kinder. 2. For some individuals, “addressing” their trauma may not be accessable and/or to do so without necessitated supports may cause more harm. 3. For many providers and peers, this is being a whole new fronteer. One that should require much wisdom, expertise, compassion and insight. In our quick fix society, the time it may take to heal for those most impacted requires a new world view of brain plasicity & the abilty to heal.

I appreciate some leaders in the field of addiction and mental health combining their resources to come up with something “definitive” insofa as what recovery is concerned. This definition coupled with the priciples of recovery are HUGE.

Elizabeth,
It depends on who’s recovery you’re talking about.
As a whole, abstinence is not a requirement for recovery; the absence of “dependency” symptoms is (see the DSM-IV’s discussion on “sustained full remission”).
Many of those who meet the (DSM-IV) criteria of substance dependency have successfully achieved this through moderation (see The National Epidemiological Study of Alcohol and Related Conditions, published by NIAAA). For others, the absence of symptoms (their harm reduction) comes from total abstinence.
This honor and reflects the first three components of SAMSHA’s definition of recovery: it is person-driven; it occurs via many pathways; and it is holistic.
(See also the works of Alan Marlatt and Andrew Tatarsky, et. al.).

As an ex-offender–as well as an Addictions Counselor who has worked with the same during the last 19 years–I suggest that the Criminal Justice system (in combination with the adverse affects of chronic chemical abuse) has been instrumental in the recovery of many alcoholics/addicts. Many have credited their confinement, which provided them a unique opportunity–which wasn’t possible while they were on their “missions”–to really do some soul-searching (personal inventories). It was during those latter moments that we were able, without distractions, to explore some of the personal information that we acted upon, that led to the thoughts/attitudes that resulted in the decisions that preciptiated some of our aberrant behaviors. Garbage In, Garbage Out (GIGO). If we had poor/insufficient information to begin with, then we could only make poor/insufficient decisions based on that information; and, of course, that’s why we ended up behaving in a manner which caused our incarcerations, addictions, homelessness, unemployment, divorces, etc. Many of our consumers (who were/are ex-offenders) have expressed the attitude that we were “rescued”, rather than “arrested”. Personally, this writer feels that incarceration is one way that GOD assures that he gets our undivided attention. As for the “Working Definition of Recovery”, I embrace it. It agrees with my philosophy of “Eliminating Excuses, and Promoting Self-Sufficiency”

This blog entry was discussed on the [DualDx] listserv. I’d like to offer my comments here as well.

The phenomenon of our field struggling to define “recovery” is
astonishing. The SAMHSA effort seems to be motivated around how to
decide what resources to make available to efforts around addiction.
That’s a noble effort.

Some earlier work to define “recovery” got bogged down in other ways,
like deciding if total abstinence was or was not an element of recovery
and whether those treated with buprenorphine or other medications are
in bona fide “recovery.”

Deciding what resources are needed to address a problem is important
and practical. Defining “recovery” for other people, however, is
absurd.

Do we ever hear of endocrinologists convening a conference to define
“recovery” from adult-onset diabetes? Or even psychiatrists arguing
about how to define “recovery” in regards to bulimia or anorexia
nervosa? Or even FEMA and Red Cross professionals arguing about how
do define “recovery” from an earthquake?

“Recovery” from a disease, disorder, natural disaster, or personal
crisis can only be defined by the individual who suffers. We only
create confusion when we try to create an idiosyncratic vocabulary for
the addiction field by enshrining the clinician’s vision as the only
way to justify a human being’s goals.

Clinical professionals stick to a professional vocabulary when
communicating with each other. That is, clinical professionals use
words like:

Your view of “recovery” and “recovered” is quite obviously influenced by your profession.

In both Cambridge and Oxford dictionaries the word is clearly and indisputably tied to a “return” to a PREVIOUS preferred, better or higher condition.

Whilst “the subjective experience of individuals struggling with a problem” may be part of many so-called treatments, it can hardly be part of a definition – unless one has a struggling medical agenda to promote.

But the history of failed psycho-pharmaceutical treatments of the last 60 years demonstrates that the cure of addiction is not a matter of medical treatment. The most widely used and successful 12 Steps system is non-medical and non-treatment, but involves training coupled with fraternal support.

Addiction recovery training in self-help “do-it-for-yourself” techniques was established 45 years ago, and is successful in the vast majority of cases, as proved in 169 centres across nearly 50 countries.

Their goal is: “a lasting return to the natural state of non-criminal relaxed abstinence into which 99% of the population is born”.

Because medical treatment of substance addiction seldom if ever achieves that goal, is no reason to deny its validity by talking about or justifying struggles and problems.

I assume that like most of us, you were born drug-free. If you allow yourself to become addicted, then recovery is no more and no less a return to your original natural state of relaxed abstinence.

Or would you prefer a continuing struggle, rather than the abandoning of antiquated concepts of addiction in favour of learning how and why it starts, and how the individual (and no one else) can handle it himself – provided he is trained so to do?

I believe Mr. Eckersley is addressing my academic degree more than my comments.

Addiction can (and must) be viewed as multi-faceted. The biology of addiction is just one facet. Psychological and social aspects are also crucial.

Regardless of whether addiction is a medical problem, a wider clinical problem, or some kind of personal, existential problem, the matter of defining “recovery” is similar.

That is, the person struggling with the problem is really the only one who can define “recovery.” For a professional to try to define “recovery” for any client is inherently paternalistic and condescending. It is a form of inappropriate boundaries of the professional.

Heraclitus said “one can never bathe in the same river twice.” The water one bathed in before has already travelled far away. That is, a complete return to any prior level of functioning is NEVER 100% possible, whether the problem is a chronic mental illness such as addiction, or prior athletic ability, or prior psychological states. The challenge in facing any of these problems is what kind of state one wants to achieve, not whether one was at a particular state before.

This has to be defined by the client. In sorting out how to help a client, professionals must set standards that use professional vocabulary, not confuse professional judgements with the personal goals and needs of clients.

Some people use substances inapproproprately (abuse) and are considered alcohol or drug dependent. These people who abuse alcohol/drugs may be able to reduce their use and consider themselves in recovery. But for people who are physically addicted, they must remain abstinent to achieve true recovery.

Substance use disorders are only one mental health condition and if, when the definition of recovery (from substance use disorders) does not include sobriety it minimizes and delutes the very characteristic that enables those drug dependent to achieve a full and meaningful life.

Because the Betty Ford Clinic and others realized that because the term “recovery” was widely used but did not have a standard definition it has “hindered public understanding and research” Thus a number of researchers, treatment providers, recovery advocates and policy makers were convened to develop a initial definition of recovery as a starting point for better communicaiton. Their work produced a report that provided not only the definition but general premises and guiding principles.

Again, as a (behavioral) healthcare worker, recovery = the absense of symptoms (to varying degrees, and through various methods). Professionals who insist on more than this — that recovery must be robust and include “abstinence” or the Promises attained through a particular recovery method — are dictating clinician-centered “treatment” and not providing patient/client-centered care.

As a Trustee and now Secretary of a charitable international addiction recovery training and education centre, with 37 years of hands-on experience of helping addicts recover THEMSELVES to lasting relaxed abstinence, I can assure Steve that there is no clearer statement of a “client’s” personal goals and needs than the one he or she makes on enrollment for recovery training services.

Roughly eighty percent categorically state “I want to get my life BACK AGAIN”, or “I want TO RETURN TO a life without drugs”, or “I want TO GET BACK IN control”, or “I want to feel LIKE I USED TO”, etc., etc.

The other approx 20%, who are generally enrolling as a result of concerned and helpful family pressure, usually make no mention of the fact that they have NO DESIRE to stop using addictive substances for one of three main reasons:
1) They love their highs so much that that is all they live for, or
2) They have tried and failed to stop using so often that they can no longer confront further failure and disappointment, or 3) They are suffering from some neurosis, psychosis or paranoia, and are using their drug(s) of choice to self-medicate, and have no wish to withdraw and again face their mental “demons”.

“Recovered” or “recovery” may be part of their vocabulary. but is not part of their thinking or intentions. They wish only to maintain their own status quo – usually without so saying.

So we are concerned not with professional targets or definitions, but only with the way in which the 80% of those who wish to be cured define their recovery goal.

And that is most often summed up as: “A lasting return to the natural state of relaxed abstinence into which I was born”.

Seldom if ever have I or my colleagues come across anyone enrolling who seeks “recovery” on the basis of being able to “take it when I want to without again becoming addicted”.

The clients know well – better than any non-user – exactly the power of addiction over their lives, and for them escape from it is not towards another unknown set of circumstances, but back to an earlier known and appreciated non-using life.

Most people new to addiction don’t understand nor do they distingish between addiction treatment and addiction recovery. Perhaps a better definition would define addiction treatment include the recovery process within it so that a person new to the problem might understand it better. It might also help families get a better idea of what is needed to help their loved one.

All of this time, resources and thought spent trying to define a state of being is contradictory of itself. How is it possible, in the true sense of the word, to define or determine what ‘recovery’ is for another person. I equate these thoughts and ideas to one person telling another person that the way to internal health is eating a vegetarian diet. Could this work, yes, however it is not the only path to achieving better health, it is only one way and therefore there are as many definitions as there are ways of achieving ‘recovery’ or whatever it may be that follows this intrinsic variety. Just a thought.

Why are all you folks trying to complicate this issue? Legal, medical, clinical or plain-old psychobabble language doesn’t make their definition any better. For those in recovery simplicity is the key to success. Amoungst yourselves use any language your field prefers. When talking with the addict KISS (Keep It SImple Sweetheart)! Nice job SAMHSA.

I appreciate the difficulty (and importance!) of crafting a definition of recovery. I hope my comments, which are generally critical, will be understood to be supportive of the effort to find clarity about this important issue.

This working definition emphasizes that recovery is a ‘process of change’ and that the process is the result of the work of an individual. But the vast majority of people in twelve step programs would never emphasize this. They would emphasize the opposite–that the process of change was not possible on their own, as the result of their individual work. In fact they would say that it was essential to experience the inability of their ‘individual work’ and ‘striving’ to solve their problems–that it was essential to experience their individual powerlessness and to find a community within which this powerlessness was not a source of shame. The ‘process of change’ for people in twelve step programs begins after this painful recognition of powerlessness. I realize that the notion of ‘powerlessness’ is controversial and complicated–particularly when both mental health and substance abuse are in view. But I don’t see how any working definition of recovery which is this fundamentally incompatible with the basic instincts of the twelve steps can hope for wide acceptance within that part of the recovery community which has found the twelve steps to be helpful.

This working definition emphasizes recovery as a self-help strategy. The idea is to work hard(to strive) to improve my own health and wellness etc. No one would deny that recovery is hard work. But this is not the emphasis you will find in twelve step programs. In twelve step programs the emphasis is not on the efficacy of self-help, but on the need for help from a resource more powerful than ourselves. Clearly a number of definitional complexities arise at this point. How can we speak of ‘powers greater than ourselves’ in ways that are not offensive? I do not claim to have any particular wisdom about how to solve that riddle. But I do think that a definition of recovery that systematically excludes any reference to the involvement of “God” or “higher power” (or even supportive community!) will not accurately reflect the actual lived experience of people in twelve step programs.

I understand that crafting a definition of something as complex as recovery involves paying attention to a particular audience, a specific end-user for the definition. If your audience is policy makers, insurance companies etc., then my input may not be particularly helpful. If, however, you want a definition that people in twelve step recovery recognize as accurately reflecting their experiences, I think some major changes in this definition might be required.

Call this a devil’s advocate’s point of view, but can someone please provide a definition for those with a concurrent diagnosis. Hypothetically speaking, someone who has major-depressive disorder diagnosed at age sixteen and then develops an addiction to cocaine later in their twenties, is at what point recovered? Is it when their cocaine use ceases or is it when they come off pysch meds for their depression (assuming that they take them)? Basically what I am saying is this:
Let’s not spend another moment trying to define that which cannot be so. Instead, lets try and collaborate and spend our thoughts (be aware of the wording of this) on helping in those areas that are more finite.
What is the largest number in our system of numbers? We assume that there is none and yet we still explore numbers and their relationships. Lets all take a lead from mathematics and work with what we know to be so and not to turn a phrase and define the infinite. Just another thought.

I suggest that a ‘definition’ will come via the progress that we make in other areas of this science. The more we understand and the more that we learn will only help to provide this type of definition, if one is truly needed. I can say with confidence that providing a definition for recovery will make no difference in the day-to-day of those who are working towards it. I asked someone recently who is in the very early stages of recovery what they felt the definition should be and their response was that ‘they didn’t care, just as long as they did it’… I didn’t ask any follow up questions because what I realized is that this persons interests weren’t in the area of defining the process they recently started, rather it is to complete the process and to take from this process tools for helping them avoid a re-start down the road. I don’t think I could agree more. Just a thought

How is this substantially different than the definition that was arrived at in October 2004 when over 110 experts gathered and came up with a definition? That 2004 definition is in place and being used by agencies all over the country and I’m not sure why this needs to be revisited every five or six years. SAMHSA went to a lot of time, energy and expense to print up brochures with the 2004 version and I don’t understand the need to change.

Recovery is both a process and an outcome–the recovery journey is inextricably linked to a destination. That said, an understanding of recovery will not emerge simply from the crafting of a shared definition among experts and consumers, nor putting it into play as a political artifact to drive public policy. Rather, our understanding of recovery will require attention to the scientific literature (including first-person accounts) and the scientific testing of rigorous theoretical hypotheses to search out its core ingredients, dependent and moderating variables, and outcomes. Some of this work is beginning to bubble up in the journals in the study of the dynamic relationship of the promotion of well-being, the role of hope, and the building resilence. I recommend that we explore the universe of recovery possibilities before we narrow its meaning and function.

I read the proposed definition and immediately thought, where is the concept of abstinence in this? I see others have addressed this in their comments. I have a background in social work and am currently a drug court coordinator. I do not think the criminal justice system can simply “forgive” people who commit crimes simply because they have a chemical dependency diagnosis…. try telling that to families who have lost someone to a drunk driver, MADD will be REALLY MAD. That being said, NOT addressing the chemical dependency issues for many folks who commit crimes results in those same folks coming in an out of jails and prisons. The criminal justice system, I believe, can help addicts embrace recovery by not only holding them accountable but kicking them in the behind to get into treatment and follow through. This works especially well when those who are addicted and break the law are allowed opportunites such as drug court and/or DWI court. Recovery then will have to embrace the concept of abstinence.

I WOULD LIKE TO SEE SOMETHING IN THE DEFINITION ABOUT ACCEPTING RESPONSIBILITY FOR MY RECOVERY. TO LEARN RESPONSIBILITY OR TO RE-LEARN RESPONSIBILITY TECHNIQUES. IE: WHEN I SAY I AM GOING TO DO SOMETHING I NEED TO FOLLOW THROUGH WITH IT, REGARDLESS HOW MUCH I ENJOY OR LIKE DOING THAT TASK OR PARTICULAR RESPONSIBILITY.

Can there be something in the Recovery Model that addresses people with serious mental illnesses who have no insight? They care cannot be self directed when they don’t realize they are ill? What are the recommendations for their recovery and how can their loved ones be of assistance?

I appreciate the dedication to create a working definition for recovery, and your willingness to solicit feedback on a topic with such an enormous scope. It will be important not to over-complicate this, as it appears you have done in your initial attempt. Thus, I will try to keep my comments simple (not always an easy task). The first concept of the definition that might be improved by inserting the word “positive” prior to “change.” Since addiction creates a steady stream of misery, and negativity, it is important to include the cognitive strategy of always looking for positives in recovery.

The second concept, “improved health and wellness,” in my opinion, begins an unhealthy descent into a recovery determined by self-will, though I realize it is probably an attempt to begin empowering the recovering person. Since definitions of “health,” and “wellness” will very widely among individuals, I think the definition could be enhanced by adding a single unifying concept, such as “realizing” improved health and wellness.

Thirdly, along the same lines as the previous proposal, is the overwhelming diversity of what might be “meaningful” to individuals in recovery. For example, a “meaningful” behavior to a recovering addict, or person with mental illness may, in fact, be very destructive to themselves and/or people around them. It may be appropriate here to mention a trap in which many professionals have fallen – the assumption that the client/patient really believes as they do; i.e. – “meaningful” is a good thing. Thus, maybe this concept should be left up to the individual by removing it, or changing it by substituting the idea of “usefulness.”

Lastly, in the spirit of simplification, let’s look at the phrase, “striving to acheive their full potential.” While this goal is perhaps a simple definition for life, it can be a path full of discouragement for a person who has never known when “enough is enough.” While this concept is necessary, and honorable, maybe the language could be altered in order to be more easily measurable. For example, “while seeking to acheive positive potential on a daily basis.

The Twelve Step Movement that began in the 1930’s discovered the extreme self-centeredness of the alcoholic/addict. The solution, as originally mapped-out in the book, “Alcoholics Anonymous,” focuses on the need for assistance from others in order for the individual to acheive recovery. This endeaver by SAMHSA to create a universal definition of recovery, is the kind of help that will further the cause of recovery in a world that leans so easily on principles of addiction

Lasting abstinence from addictive substances is the foundation for also abandoning criminal behaviour, for again becoming employable and for regaining good health and well-being within the family and community, as well as independence from the so-called “treatment” system.

But let us not forget, that whilst Betsey is also right to advise that rehabilitation plus criminal responsibility is the proper route, most psycho-pharm recovery “treatments” do not work.

What does work is “training” in do-it-for-yourself addiction recovery self-help techniques which deliver the necessary knowledge, restore responsibility and permit the former addict to once again control his or her life.

I particularly like your principals. One aspect that could be added is the idea of self determination which I feel is the will and the desire to sustain health. It does not matter its place of origin but that it exits. It is the desire and ability to move through and create new beginnings with support and self growth.

Thank you to all who worked on this project and came up with this definitive conclusion. After many years in the treatment field, for MH and SA, I would add that two ingredients required for long term recovery are humility and gratitude.

I wish we could teach these attributes but, alas, they appear to be gifts of character.

Although one can never say “recovered” from addiction, that is forever, one can say after many years of working on their recovery that they have “recovered” their life and that they are living it.
Recovery is sometimes a negative word as the implication can be that I will never get my life back so here’s another drunk-a-log or drug-a-log. I tell my people that being in recovery is coupled with the fact that they are living their life – as it is- now.

I think you all are thinking too much. Recovery is a state of mind that all people should strive for not only people who are mentally ill or addicted. My definition of Recovery is when we wouldn’t want to be anyone but ourselves. No matter who you are if you do not like yourself you need to change until you do like yourself and again wouldn’t want to be anyone else. On a side note self-esteem is how we feel about ourselves on the inside, if you turn that inside out that is confidence. Confidence is the ability to project your self-esteem publicly.

Okay, I understand now that “recovery” needs to be defined in such a way that it can be paid for by Medicaid or Medicare. Insurance companies need to have information so that they can pay until “recovery” has happened and then they don’t need to pay any more.

The problem is that recovery isn’t just a medical phenomena. Two soldiers can lose a leg in the middle east. You might talk to them and come to the conclusion that one is recovered and one isn’t although neither regained a limb. We’d understand that. The one who is recovered defines himself as a person first who may have a disability but isn’t disabled. The other may see himself only in terms of his lost limb and his life would revolve solely around his disabling disability.

Recovery is something of a state of mind about your essential self. That makes it hard to define in a medical enough sense to allow for it to be paid for. So, we resort to the consensus definition to have something that can be paid by insurance.

i am concerned that we not develop too narrow a definition of recovery. Recovery programs, for some individuals, become like religiioin, in that anyone not participating in their particular recovery community, is judged to be either not TRULY in recovery, or at the very least, not in healthy recovery. Anyone who previously suffered consequences of substance use, and continued to use, who now does not use, or uses in such a way so as to not experience consequences or impose on the safety or well being of others, is in recovery and should be supported. I have friends in 12 Step recovery, friends in medication assisted recovery, friends in recovery from narcotics addiction who drink sociably (heresy) and friends who got sober in faith based programs. They may not all live their recovery the way I wish to live mine. But I am not entitled to sit in judgement on their recovery as long as they are sober. And I woul dnever presume to do so. The person who needs to be comfortable and satisfied with their individual recovery is the person in recovery, his/her family and their community. In fact, I seem to remember hearing a suggestion once that we not take the inventory of anyone but ourselves. Incidentally, in April, I will have been in recovery for 40 years.

As a recovering alcoholic and/or drug addict with numerous character defects, I’ve always felt pretty comfortable in knowing that I was in recovery from my addiction to abusing alcohol and/or drugs. Now, a bureaucratic organization (SAMHSA) that is awash with academic analysis paralysis and bureaucratic constipation has gone and messed with my mind. Some 70 years ago, Alcoholics Anonymous defined the problem and even came up with a solution to the problem.

No wonder SAMHSA has had little impact in reducing a cancer that is eating away at the economic and social foundation of our society … they haven’t even figured out the problem yet.

Thank you for the new woring definition and set of Principles as set . I knew eight years ago that sooner or later positive psychology and life coaching was gong to impact the substance abuse and mental health community . This new definition ,,falls in line with the following the Qualityf life Therapy book by Michael Frisch and Michael Arloski book wellness coaching for lasting lifestyle change , what every one needs to read is life coaching for Dummies . Now am a former Heroin addict and alocholic been in recovery for more than 35 years and never attendted 12 step groups , I also have been a substance counselor and criminal jusitice counselor for more than 35 years , also use to be a probation officer . I have come to the conclusion that 12 step groups is not for every body for some its what they need and ohters not . So much for my comments

Thank you SAMHSA for creating this “Open Dialogue” on Recovery! It is my hope that through this open dialogue, we can learn from each other. At 14, I was drinking and sniffing fumes. At 16, I was living on my own, putting needles in my arms. At 17, I watched a best friend die from Hep C. I never put another needle in my arm. Someone gave me a book about a Tibetan Monk. I started reading about meditation and became a practionoer. I learned I was doing drugs to self medicate. I was trying to deal with a sureal childhood in which life had not been kind, where I asked myself day to day, “would I live to see tomorrow?” After 10 years in the computer industry, a few career changes along with an unforseen traumatic event related to 9/11, I am a firm believer in Recovery, Resiliency, & Hope. I did not use a 12 step program, though my father found wonderful support and connections there. I cherish his 12 step books he left behind, as they are a big part of us getting to know each other better before he left this world. I am now an advocate for “Trauma Informed Care”, Recovery Coaching, and Peer Support. In the end, for me, it is about Healing, making amends where possible, and attaining a life where one can Thrive to the best of one’s own ability. It is about building relationships built on profound Trust & Respect, even when there are differences, regardless of which paths we choose.

“Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.”

Wow. this is the main part of the draft definition for “recovery” and because “recovery” – rather than “RECOVERED” has been chosen for this apparently endless “defining exercise”, we of course find ourselves with an endless no final outcome procedure.

But “recovery” is not just a process. When we say: “He has achieved recovery from substance addiction”, we mean he has returned to the natural state of non-criminal lasting relaxed abstinence into which 99% of the population is born.

Any definition which falls short of that outcome is avoiding the issue and trying to include interventions that can possibly never attain that “recovered” description, which is what can be properly applied to the guy who can say: “I have completed my full “recovery”.

TIME and a recovery JOURNEY’S END must therefore be included in a proper definition, and not just left disguised and hanging under a phrase like: “while striving to achieve their full potential” !

In fact, many of the comments and proposed definitions (apparently by those who do not actually know HOW to bring an addict to lasting abstinence) seem calculated to make absolutely sure that abstinence is never part of “recovered” or “recovery”.

I believe that a definition of recovery from substance abuse or alcohol should, at some level, include the concept of abstinence. I am not critical of 12 step programs that have helped so many but, the concept of powerlessness is not one that is very compatible with folks who are trying to recover from mental illness. A vast majority of mental health folks have survived abuse, neglect and trauma and are seeking to regain their personal power as part of their recovery. Another difference is that mental health folks often struggle with overcoming institutionalization (even without walls) and must overcome this second level of traumatization to work toward recovery.

Recovery is a choice. We can work on our issues and have all the supports in place we need but if one does not choose to utilize these coping skills and these supports it is all for not. Working in this field I have found that at any given time someone can choose to make a difference and recover and put in the work or one can choose to continue in their disease. It sounds simple but it is oh so complex. You can get therapy for trauma, but you will need to choose to apply the skills and you must choose to become better.

I question the value of a generic, over-simplified, trans-theorhetical definition of “recovery” that the field can apply to abuse, dependence, & mental disorders. IMO, it’s overly ambitious and ultamately sophomoric.

While I can understand the utility of “Stages of Change” as a useful model to describe the general change process, it completely omits any concrete tasks which are required to acheive change. Further, attempting to label this as an “idividually identified & driven” process discounts and de-values the efforts of professional change agents in the field. While growing and harvesting fruit shares many common processes, there are distinct differences between, apples, oranges, grapes, pineapples, and tomatoes which require specialized environments and care. Having success in your apple orchard does not mean that you could enjoy any success cultivating and harvesting pineapples, it also does not qualify you as an authority when addressing the tomato farmers. While I think your heart is in the right place, I believe this effort will result in more confusion in the field and may ultimately undermine future “recovery” from a chronic, primary, neuro-physical disease.

Why doesn’t anyone ever mention the work and time it take to recover. It doesn’t happen over night but is a journey of life. If we get to picking recovery apart we could go on endlessly. Everyone is in recovery from something, abuse, divorce, grief and so on. So wouldn’t it make sense to ask everyone what recovery is to them, we might learn something by stepping out of our realm.

Webster dictionary defines recover as 1 “to get back again”, ” retrieve, regain”, 2 “to regain normal health, poise or status”. What does that mean individually as it relates to addiction, mental health or medical conditions? Recovery should be individualized so that it will maximize ones own potential. How do you spell that out in the Recovery definition.

Using the webester definition, what would the individual “get back again”, “what are they retrieving”, or “regaining” from having a mental illness, or medical condition, or drug and/or alcohol addiction? Isn’t treatment used to move the client forward, to a level of stablity, functioning at level of responsbility? I wanted to take part in this to see where my thoughts are about recovery. My first reaction was to look at the webster’s definition and with that definition, I identified my thoughts.

Secondly, do we really recovery from these conditions, or as defined by Webster “regain “normal health poise, status or do we move forward with treatment of these conditions, be it medical, mental health or addiction, and hope and expect that we will we can and will grow, learn and gain stablity in our lives, accept and adjust to these conditions as individuals, and each idividual’s response is going to be different. The affects of the condition(s), or the treatment process has change us or has moved us to a different state/level.

We use the term recovery all the time with everything, finances, jobs, mental state, medical conditions, etc., with these life events, at our own pace as indvidual, because we respond to these type of love events, differently, but we move forward, we grow. These are just my thoughts. I apperciate the opportunity to give input. Thank you

Recovery,
It is a process of change throught which individuals work to improve their own health and well being this may be true possibly for adults but recovery for children can be very difficult. They are the last to be chosen to play and the first to be blamed. Their illiness aren’t fatal most of the time but a small part of their hearts and souls die with every rejection. Their behaviors sems odd or unpredictable to themselves as much as to society. They are misunderstood and over looked thus the name “Forgotten Kids. Maybe I can bring understanding by showing and profiding insight into the life of my child struck with mental illiness and hopefully people will realize that my child is just as special as the next. Mental Illiness doesn’t just effect the child but the whole community. Until society bcomes more aware and acepting of mental illiness our future kids with these disabilities will truly not recover.

I have worked in the chemical dependency field for 20+ years as well as treating general mental health. The proposed definition is not bad. However, in the last several years I have seen a push to “blend” mental health and addiction which I think is a mistake. Yes, many individuals with addictions have mental health concerns and visa versa. these issues can be addressed. However, traditional “recovery” such as treatment, AA, 12 step recovery programs, community support and gaining life skills are still the most successful when dealing with chemical dependency.Trying to make ‘recovery” the same for both does not work. While all the posts share helpful suggestions, it is obvious that there are two definate ways of thinking and we need to keep the two separate and just “keep it simple”.

I believe Recovery and /or Resilience is more about the journey, than what it is called. I also think the entire concept is what a person decides for themselves,
using the limited tools they have available.The words Recovery+ Resilience are ok. There are those of us who are dedicated to making the space for people who
have a hard to worse time living a full life, what ever that means for each person.
I think a tough experience is working in an MH agency where ” Recovery” is
shamlessly used to market the agency ie fund raisers, getting grants and convincing the community that the entire agency practices the principles of
the currant definition of ” Recovery” as leadership states ” we don’t need to
practice recovery at this level “, this creates or maintains the us and them
approach, which is one of the reasons transformation of the mental health system will most likely not continue any real growth or move forward.
Those who create this dicotmy seem to be blissfully unaware of it.

To this day, the White Man culture of individualism continues to pollute the Native American culture of community. As a result, Native Americans justifiably do not like let alone respect or trust the White Man. Instead of sitting down with a willingness to accept the Native American culture and develop federal policies to empower Native American people, the White Man bureaucracies forced (via massacres, plagues, alcoholism, etc.) their own culture and values upon the so-called savages.
Unfortunately, the same theory seems to be fashionable with today’s mental health vs. substance abuse debacle. Gail Chmielewski (August 25 post) is correct in stating: “Trying to make ‘recovery’ the same for both does not work.” Reality is the fact that the mental health culture looks down upon the culture of alcohol and/or drug addiction just as alcoholics and/or drug addicts generally want nothing to do with the mental health culture. Meanwhile, in their own cloud of self-righteousness wisdom, the mental health bureaucracies continue to lobby for consolidation of the two cultures. Just as Native American policy should be a vision of Native American people, alcohol and/or drug policy should be a vision of recovering people – not the self-serving paper drunks, lobbyists and mental health bureaucracies.
Why it is paper drunks (calling themselves “experts”) are the ones developing alcohol and/or drug policy? (I’ve always heard that “expert” is defined as “someone that is 50 miles away from home”) They may be “experts” in reading, research and publishing but I fail to see how their knowledge supersedes those of us that have lived (and continually recover from) the life of a drunk and/or drug addict. Let us not forget that it was the so-called Indian “experts” that devised and implemented our government’s infamous Native American annihilation policies.
In 1970, the Hughes Act was enacted to do something about a cancer eating away at the economic and social fiber of our society. At its inception; the Hughes Act was a joint venture between government bureaucracy and a recovery vision. Unfortunately, the lobbyists and bureaucracies soon took control of policy development and its original intent went out the window – along with recovery participation. As a result, the problems associated with alcohol and/or drug addiction continue to worsen as the over-abundance of bureaucracy’s continue to proliferate – all at the expense of the American taxpayer. The intent of the Hughes Act was to do something about a problem, not create an industrial complex that is awash with bureaucracies that seem content in doing the same thing while expecting different results.
Jim Russell
The Spirit of Recovery Foundation, Inc.
spiritofrecovery@cox.net

Family Voices-NJ is part of a national network that works to “keep families at the center of children’s healthcare.” We are housed at the Statewide Parent Advocacy Network, which is also a chapter of the Federation of Families for Children’s Mental Health. In addition, we volunteer with the National Alliance for Mental Illness (NAMI) on the local/state/and national level. We agree that there needed to be a common definition of recovery to include both mental health and substance abuse. Recently in our state there was a merger between the Division of Mental Health and the Division of Addiction Services.

We strongly support SAMHSA’s model of recovery. Much of NAMI’s work involves raising awareness of mental health and countering stereotypes. NAMI’s philosophy is that a brain disorder is a brain disorder, period. It doesn’t matter if it’s childhood schizophrenia, bipolar, autism, ADHD, Tourette’s etc. They help families realize that mental illness is like any other illness, but the organ affected just happens to be the brain, which manifests as behavior. NAMI reduces the stigma associated with mental illness and offers hope in recovery.

However, we want to emphasize that the mental health needs of children differ than those of adults. There needs to be initiatives related to screening, prevention, and early intervention for children which will reduce costs and improve outcomes. Interventions must be based on the child’s developmental level and include family support.

We strongly support the definition as “person-centered” This holistic model incorporates the whole person, family, and community. In the disability field, there is much emphasis on person-centered planning as it relates to self-determination and self-advocacy with respect for the wishes of the individual. We support SAMHSA’s model as strengths-based as so often the focus is on the illness and what the person can’t do, rather than building on their capabilities. This concept is in keeping with the “patient centered medical home” model. There is shared responsibility (i.e. shared decision-making). Again, this must also include the community, and community-based supports, which are mutually beneficial through cost-effectiveness but most importantly keeping individuals in the “least restrictive environment” in their communities where they belong. It is imperative that this been done in a culturally-competent manner, especially for what may seem to be a more sensitive area, mental illness. We are pleased to see SAMHSA’s new definition of recovery for both mental health and substance abuse which includes the principles of being “person-driven, …holistic….culturally-based…involves individual, family, and community strengths and responsibility…and is based on respect…and hope.”

Thank you for your courage to state what I agree are well-hidden truths regarding the “money lobby” of government that decides where “treatment” dollars are spent. I first learned of the Hughes Act as a patient in treatment in 1994. As an original initiative, it must have provided immense hope for many victories over the suffering and death of addiciton. Tragically, just as with your people, the “White Man” has used the lust for money and power to plunder the innocence of love and service to your fellow human being.

Thankfully, our Great Spirit, God will continue to change the lives of those who look toward Him.

In Grateful Contemplation of the Brotherhood of Humanity,

Michael Dorsey

P.S. – I am a man whose skin is white, though has learned through recovery that all hearts are the same color.

I think it is very important as we move forward to include the words Mental Health as much as we include the words Substance Abuse. there are some places where Mental Health is left off in the recover support initiative and without mental health there can be no health.
I also think the National Mental Health Planning and Advisory Council is an important piece to the future of Mental Health. As we go forward we need to unify Substance abuse positions(consumers, family members, and stakeholders) into these councils across the nation.

I’m very amazed of all great comments here. I really appreciate the time and effort for given us more understanding for the mental health process. Absolutely, it gives me awareness as well. Keep on posting!

The definition of recovery doesn’t even fit all people who are mentally ill, so how it supposed to address everyone with a mental illness and/or a substance abuse? It doesn’t even address those who have mental illness and are unable to direct their own care. So Bill, I think SAMHSA agrees with you too.

Wow, folks sure have a lot to say about recovery. I have attended countless anonymous meetings but only attained sobriety ( complete and total abstinence) by switching to secular Organiztions for Sobriety. I’m now in my 24th year of sobriety. For me, sobriety is my priority above all else. The problems I face in my life are completely separate from my sobriety. I submit that a lot of alcoholics / addicts don’t make it in a 12 step program because it is a wrong fit. We, in the addictions field should be familiar and conversant with sobriety groups like S.O.S., Women for Sobriety, SMART recovery and other secular groups. We do harm to our clients by keeping them unaware of the many choices that are in our communities, and by the way, you can’t define recovery for me. I’m an individual and not powerless !

I like what you said about “Recovery is a process of change whereby individuals work to improve their own health and wellness and to live a meaningful life in a community of their choice while striving to achieve their full potential.” The essentials of a good recovery is a dynamic of a proper diet to cleanse the body and the loving support of family and friends.

It’s good to see government initiatives starting to take a more person-centered and holistic approach to healing. These principles of recovery are certainly worth pursuing and will probably prove to be more effective than some initiatives of the past.

I appreciate the effort to define recovery, why some comments question the need for a definition is not clear to me. Working towards a definition can only improve the understanding of recovery.

The definition provided is broad enough on a general level, but “…live a meaningful life in a community of their choice…” seems too narrow. If the definition of recovery is meant to describe the final result attained after the process of recovery (if this is even a process that can be completed) I would probably agree but would also mean that people “in recovery” are different – right? Am I missing a point here? I believe that many people in recovery do not live in communities of their choice, especially if they are incarcerated, which in some cases means that if we apply “…live a meaningful life in a community of their choice…” some of these people will never recover.
And.. this snippet from the definition asks for another definition: What is a meaningful life?

Thank you SAMHSA pertaining to developing this particular open dialogue upon Healing. It is our hope in which through this kind of wide open conversation, we can learn from one another. It’s excellent to view government attempts beginning take a more personal and healthy way of therapeutic. These types of principles involving healing are extremely really worth going after and will probably show to be more efficient compared to some projects. My partner and i fully support SAMHSA’s project while strengths-based since so often the target will be about the disease along with exactly what the individual can’t perform, instead of creating on the functions. This concept is preserving the actual “patient based medical home” model. looking forward for future programs from SAMHSA.

Thanks SAMHSA and all who participate in constructing this wonderful program. Great post and keep up the good work. I would like to see more programs going in this direction and it is great approach compared to other methods.